How can I regain the desire to do things?
Summary
Psychotic disorders are often associated only with symptoms such as hallucinations or strange or delusional ideas. But there are other symptoms that are equally or more bothersome or difficult to bear, which we call negative symptoms . Among them, apathy, lack of motivation, difficulty feeling pleasure and social isolation.
These difficulties or symptoms are not exclusive to psychotic disorders, but can be present, and in fact are very often present, in other disorders such as depression, so the way to face and overcome them can be very similar in all cases, with only some differences. But before trying to address how to overcome them, it is necessary to understand what we are talking about when we refer to negative symptoms in psychosis.
What are the main negative symptoms of psychosis?
When we talk about negative symptoms, it seems that there are positive or beneficial ones, or that the person is negative for experiencing them. And this is not the case. The symptoms are not negative in themselves, but refer to the loss or decrease in the person's usual functions , which affect emotions, abilities, motivation and relationships.
The main negative symptoms in psychosis are:
- Apathy: occurs when it is very difficult to start or maintain activities (studying, playing sports, meeting friends, etc.). This symptom is not laziness or lack of willpower, but is a symptom derived from some mental disorders, and has a biological and psychological basis. Therefore, it has nothing to do with the person's way of being.
- Anhedonia: is the difficulty feeling pleasure, even when doing activities that were previously liked and enjoyed a lot.
- Little emotional expression: Sometimes, people with this symptom may seem cold or distant, because they have difficulty expressing emotions with facial and body gestures. They may feel emotions as more “dull” or attenuated, but this does not mean that they “have no feelings.”
- Speaking little (alogia): occurs when very short answers are given or there is a feeling of having nothing to say or not knowing what to say.
- Social isolation: it is a very intense and frequent desire to be alone and experience great difficulty in relating.
All of these symptoms affect the person's day-to-day life, but perhaps apathy is one of the things that most worries young people and families, as it makes it difficult for them to go to class, go out with friends or do all those things that positively affect their quality of life and also their involvement with their own recovery plan.
Promoting positive mental health in a first psychotic episode
Apathy, one of the symptoms that most impacts people's lives
Apathy is caused by changes in the functioning of the brain, especially in the dopaminergic circuits that are responsible for managing motivation and reward-oriented (or punishment-avoidance) behaviors.
But, in addition to these biological causes, there are also psychological ones. One of the psychological aspects that most influences apathy are negative thoughts of incapacity ("I won't be able to do it", "it's too difficult"), which often make it impossible to overcome apathy. Another psychological element is fear : the fear of feeling bad or having a bad time also slows down attempts to do things. Previous experiences of failure can also influence apathy, since if the person remembers the occasions when they have not been able to do something, they are less likely to try to do it again. Therefore, avoidance patterns can be perpetuated , and the less they do, the less they want to do it.
Negative thoughts of incapacity and the fear of having a bad time are two aspects that often make it difficult to overcome apathy.
Procrastination refers, in colloquial terms, to these dynamics. When there is apathy, the person finds it difficult to start doing things, because everything seems very useless, everything seems to require too much effort or that it will be too difficult. When this happens, the person leaves everything to do later and, in this way, does not face the tasks or activities . Therefore, the "lack of drive", which would be apathy, produces the behavior of procrastination, which is the consequence of this "lack of drive", which, at the same time, makes it worse.
What can we do to deal with apathy?
Behavioral activation
Behavioral activation, derived from cognitive behavioral therapies, is one of the main strategies for overcoming apathy. It is based on the idea that the desire to do things appears when you have already started doing them; that is, you don't have to wait until you feel like doing something to start doing it. It is the message "let the desire come to you while doing it."
In this context, it is recommended to start by doing simple activities with realistic goals . If an activity can be divided into smaller tasks, better, and start by carrying out the activities that are the most "easy to do without feeling like it."
Often, the desire to do things appears when you have already started doing them; that is, you don't have to wait until you feel like doing something to start doing it.
For example, if an activity consists of recovering the previous sports activity, which consisted of training three times a week and competing on the weekend, you can start by going to training only one day a week, choosing the day on which the activities require less effort, and gradually adding one more day, until completing the three days a week; and, later, consider going to matches or competitions. Therefore, it is not a matter of considering recovering the previous activity 100%, but rather breaking it down into parts and starting with the easiest ones. Each small activity that is done helps to reduce the negative thoughts that generate fear and avoidance.
SMART goals
Along these same lines, there is the SMART strategy, which is also part of the behavioral strategies to overcome apathy. It involves setting achievable and realistic goals . SMART goals mean specific (S), measurable (M), achievable (A), realistic (R) and time-bound (T).
For example, in the previous case, a NOT SMART goal would be: "in two weeks I want to be the footballer I was before again". A SMART goal would be: "this week I will go to the first part of training, when they do the warm-up, the gentle physical preparation and the meeting with the other teammates"; or, it could even be: "this week I will go to the sports center and greet my teammates, and I will go there in my sports clothes because maybe, if I get the courage once there, I can do part of the training".
Fighting demotivating thoughts
Discovering and fighting demotivating thoughts is another aspect to consider. Often, people with symptoms of apathy have very frequent thoughts that go through their heads, and of which they may not be aware, that hinder attempts to overcome apathy.
Thoughts such as "I won't be able to", "I won't be able to", "it's not worth it", "what will others say", etc., can come to be taken as true, simply by repeating them mentally and without contrasting them with reality.
If you experience these types of negative internal dialogues, it is worth sharing them with other people around you (family, friends, etc.), because it is very possible that they will make us realize that perhaps they are not so true. Other people are usually more impartial and objective, and can help us replace these thoughts with others that are more in line with our reality, such as: "Maybe you are not able to do a workout like before, but if you do some activity at the sports center with your teammates, maybe you will feel good and the next day it will be less difficult for you to go there, and stay there for a little longer."
Be gradual and progressive
Overcoming apathy and returning to enjoying the activities and experiences we enjoy doesn't happen suddenly or abruptly; it's a gradual process.
When we do an activity that we enjoy, there are very important changes in the brain. It's not just that we have a good time, but that the brain systems that are related to motivation, energy and the desire to repeat what we are doing are activated . The brain has what is called a reward system, which serves to indicate to us that an activity is positive or useful and that it is worth doing it again. When, for example, you listen to a song that you like or do a sport that you enjoy, this system is activated. One of the most important substances involved is dopamine, which works as a chemical messenger. Dopamine is the signal that tells the brain that what is happening is positive, interesting and that we should pay attention to it.
Doing enjoyable activities helps reactivate pleasure signals in the brain. Small pleasurable activities set this kind of reward system in motion and thus the brain is trained.
In situations or moments when you experience apathy, this reward system works more slowly or with less intensity. This means that activities that were previously enjoyable may no longer generate pleasure. But, even if you don't notice much pleasure at first, doing enjoyable activities helps reactivate pleasure signals in the brain . Small pleasurable activities activate this reward system and thus the brain is trained.
One way to understand this is to imagine the brain as a path that hasn't been walked in a while. Initially, it may be overgrown and difficult to walk. But each time you walk it, the path becomes clearer and easier to navigate. This is how pleasurable activities work: the more you do them, the easier it is to do them and the easier it is for your brain to respond again.
In this phase, it is important not to judge or self-evaluate yourself harshly , that is, to be compassionate with yourself, and to be attentive to small changes. It is okay if you have not enjoyed yourself to the fullest or as much as before.
Learning to treat ourselves well in times of pain
Self-compassion
Self-compassion is another strategy often used in therapy to deal with apathy and other negative symptoms. It involves a series of concepts that are more complex than they may seem at first glance, but which in essence translate into learning that a person is not to blame for having the symptoms they have .
Reducing internal criticism is important, since having an internal dialogue full of negative messages towards oneself makes the person feel bad and even more apathetic.
When a person says things to themselves that they would never say to a good friend, they are judging themselves very harshly and, probably, blaming themselves for having the symptoms they have. Accepting that symptoms are not voluntary or intentional , that they are not caused by themselves, and that each person has their own rhythms is a process that helps to overcome apathy, demotivation and anhedonia progressively, and thus recover functioning.
